2013 Volume 82 Issue 1 Pages 174-175
A 49-year-old woman came to our hospital complaining of abdominal pain for two days after gastrography. Abdominal X-ray examination demonstrated a large amount of barium in the colon, and the cause of pain was determined to be due to stagnation of barium. An enema was performed, but all of the barium was not removed and the pain persisted. CT scan after the enema showed a large amount of barium with halation in the sigmoid colon, but free air was not present. Colonoscopy with carbon dioxide insufflation was performed to remove the barium. After the barium was removed from the sigmoid colon by lavage, an exposed blood vessel with spurting hemorrhage and a portion of serous membrane were visualized. A CT scan after the endoscopy showed a small amount of free air and ascites in the abdomen. Perforation of the sigmoid colon was diagnosed, and Hartmann’s operation was performed.
When examining patients who have an extensive amount of barium stagnating in the large intestine, the possibility of perforation should be considered even when free air is not present on a CT scan. In such cases, endoscopic removal under carbon dioxide insufflation may be a safer treatment procedure than an enema.
